This three-part proposal presents the rationale for choosing the well-established infrastructure of the Department of Emergency Medicine (DEM) of Froedtert Memorial Lutheran Hospital (FMLH), the Medical College of Wisconsin (MCW), and the Milwaukee County Emergency Medical Services System (MCEMS) as a Regional Clinical Center for the PULSE consortium, to be known as the Milwaukee Regional Clinical Center (MRCC), directed by Tom P. Aufderheide, M.D. (PI). PART 1: Housed within the adjoining FMLH and Children's Hospital of Wisconsin (CHW) nationally recognized Trauma Centers, FMLH DEM coordinates MCEMS, including the Flight For Life Helicopter and 15 paramedic-receiving hospitals, treating 3,207 urban, suburban, and rural cardiac arrest and trauma patients annually. This well-orchestrated and proven infrastructure provides centralized emergency physician medical control and on-scene monitoring for consistent delivery of MCEMS care and the implementation of out-of-hospital research protocols. Dr. Aufderheide founded and leads the Milwaukee Emergency Medicine Research Consortium (MEMRC), an experienced out-of-hospital research association, supporting IRC interactions, continued research interventions, monitoring, and medical record review at all paramedic-receiving hospitals. Dr. Aufderheide has conducted two out-of-hospital trials requiring exception to informed consent, engendering familiarity and support for this approach throughout the Milwaukee community. PART 2: The Cardiopulmonary Arrest protocol proposal, "Active Compression Decompression CPR and the Impedance Threshold Device (ACD/ITD CPR) for Improving Outcome in Cardiac Arrest," is a randomized clinical trial comparing hospital discharge survival rates and neurological outcome in patients treated with standard manual CPR versus ACD/ITD CPR. Pilot human data demonstrating significantly improved short-term survival supports the multicenter study. Increasing blood flow during CPR with this approach has the potential to save 36,000 lives worldwide each year. PART 3: The Trauma protocol proposal, "Functional Quality of Life After Hemorrhagic Shock," is a prospective, randomized, double-blind study comparing functional outcome and quality of life in trauma patients with shock, randomized to receive hypertonic saline versus lactated Ringers as the initial resuscitation fluid. The type and quality of resuscitation affect mortality, quality of life, and neurologic outcome after hemorrhagic shock, as traumatic injury annually kills approximately 150,000 people, permanently disables 600,000, and costs society approximately $469 billion. Combining clinical and basic science, this translational research study will have significant impact by addressing this important national healthcare issue.